Dr Katherine Gardner

Learning Objectives By the end of the session you should be able to:

List the indications for catheterisation

List the equipment needed for catheterisation

Have knowledge of the steps involved

Demonstrate basic catheterisation of a male mannequin

Be aware of pass/fail aspects of the procedure

Indications Monitor urinary output (eg in septic shock)

Relieve urinary obstruction (eg acute or chronic)

Unconscious patient

Bladder irrigation (eg. frank haematuria)

Drugs or contrast (eg. intra vesical BCG for bladder Ca)

Some surgical procedures (eg. pelvic surgery)

Epidural insertion

Incontinence (sometimes)

Introduction Introduce yourself

Check patient identity

Explain the procedure in simple language o ‘Small tube passed through your penis into your bladder to help drain

your urine. It will be uncomfortable but shouldn’t be painful and we will use a lubricating anaesthetic jelly to help pass the tube’

Explain reason for doing it

Explain common complications( UTI, bleeding etc)

Check if patient allergic to Latex or local anaesthetic

Gain permission and offer a chaperone

Preparation Wash your hands

Clean the trolley

o Start on the top surface, then the legs and finally the bottom surface, using a different large sani cloth for each

Collect necessary equipment on the bottom shelf

o Think about steps in procedure

Equipment Catheterisation pack

Catheter

Lignocaine gel (eg Instillagel)

Cleaning solution (N.saline)

Sterile gloves x 2

Apron

Catheter bag

10ml sterile water if not with catheter

Inco pads

Setting up the Sterile Field Move over to patient bedside

Clean your hands

Put apron on

Open the catheter pack from outside o DO NOT TOUCH THE INSIDE OF THE CATHETER PACK!!

• Open the other equipment out onto the sterile field o Catheter, Instillagel, syringe, catheter bag, sterile gloves

• Pour normal saline into pot if able to without touching within the sterile field (if not ask assistant to do later)

Before Starting Position patient o lying on bed, undressed from waist

down

Place Inco pad underneath patient

Alcohol gel hands and put on sterile gloves

Tear a small hole in the middle of the drape and place around penis

Cleaning Keep your dominant hand as ‘clean hand’ and non

dominant hand as the ‘dirty hand’

• Draw back the foreskin using gauze (open it out then fold in half)

• Clean from the urethral meatus outwards

• Dip each swab in N.saline, - one swab to clean one direction

• Discard used swabs on bottom shelf

Local Anaesthetic Insertion Warn patient it might feel cold or stingy

Ensure you have LA syringe and not water syringe!

Put a bleb around the meatus

Insert syringe tip into the meatus

Insert all of instillagel whilst holding penis slightly upright

Continue to hold penis slightly upright for a couple of minutes

Wait a few minutes for instillagel to work

Change your Gloves! Remove your gloves and put in clinical waste bin

Clean hands

Put on 2nd pair of sterile gloves

Tear off fenestrated end of catheter packet

Catheter Insertion Warn the patient you are about to

insert the catheter

Place the kidney dish as in pic

Insert the catheter using your dominant hand

Use other hand to hold penis upright using gauze

Do not touch catheter! Only plastic wrapper

Feed catheter into the penis until bifurcation reached

Cathterisation Inflate the balloon with sterile water in syringe

Pull back catheter until unable to pull out further

(inflated balloon will keep it in place)

Attach the catheter bag

Position catheter bag below level of patient’s bladder

Clear up the mess

Replace patient’s foreskin!

Risk of Paraphimosis

To Complete Dispose of equipment in

clinical waste bin

Clean your hands

Clean the trolley

Clean hands again

Return to measure the residual volume

Document procedure in the notes

Document in the notes Can include sticker from back of catheter packet in notes

Indication

Catheter type and gauge

Informed verbal consent obtained

Sterile technique used

Lignocaine gel used + much type

Any complication of the procedure

Amount of water used to inflate the balloon

Foreskin replaced after and Residual Volume

Summary Wash hands

Introduce yourself

Explain procedure

Offer chaperone

Gather equipment

Prepare patient/inco pads

Create sterile field

Open catheter onto field

Open other equipment

Clean hands + gloves on

• Place drape around penis

• Clean penis

• Insert Instillagel

• Replace gloves

• Insert catheter

• Inflate balloon

• Pull back on catheter

• Attach bag

• Replace foreskin

• Record residual volume • Document in notes

Conclusion For Hillingdon Hospital Urinary Catheterisation protocol: http://intranet/docs/dept/Infectioncontrol/ANTT/Guidelines/UrinaryCatheter.pdf